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Published on: October 10, 2019
Pre-operative magnetic resonance imaging can predict prostate cancer with risk for positive surgical margins
M Quentin1, L Schimmöller2, T Ullrich1
1Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany.
Purpose:
Analysis of patients with pre-operative 3 T multiparametric prostate MRI (mpMRI) to determine reliable MRI-based risk predictors of patients at risk for positive surgical margins (PSM) in robotic assisted radical prostatectomy (RPE).
Methods:
Consecutive patients with 3 T mpMRI and subsequent RPE from 01/2015 to 12/2018 were retrospectively included. Patients were compared regarding clinical and MRI related parameters such as length of capsular tumor contact (LCC) and distance to the membranous urethra (UD).
Results:
Forty-nine of 179 patients (27%) had PSM in 70 different localizations, with the majority located at the capsule (57%, 40/70), mostly apical and/or posterior. The second most often PSM occurred at the apical urethra (22%, 15/70). PCA was visible on mpMRI at the localization of PSM in 93% at the capsule and in 80% at the urethra. PSA, PI-RADS classification, extraprostatic extension (EPE), and seminal vesicles infiltration (SVI) on MRI were significantly higher / more frequent in patients with PSM. LCC (AUC 0.710), EPE (AUC 0.693), and UD (1-AUC 0.673) predicted PSM (overall). An UD of ≤ 3.5 mm showed the highest accuracy of 95% (J = 0.946) for PSM at the urethra and a LCC of ≥ 22.5 mm with 77% (J = 0.378) for PSM at the capsule.
Conclusion:
PSM occurred mostly in the apex and/or posteriorly at the capsule or at the apical urethra. LCC was the best MRI predictor for PSM at the capsule and UD for tumors with PSM at the apical urethra. Using these MRI parameters readers might pre-operatively determine PCA localizations at risk for PSM.
Insights
Pre-operative 3 Tesla multiparametric prostate MRI (mpMRI) can predict positive surgical margins (PSM) during robotic assisted radical prostatectomy (RPE). Length of capsular tumor contact (LCC) and distance to the membranous urethra (UD) are key MRI predictors for PSM.
Area of Science:
- Radiology
- Urology
- Oncology
Background:
- Positive surgical margins (PSM) are a concern in radical prostatectomy.
- Accurate pre-operative prediction of PSM can guide surgical planning and improve outcomes.
Purpose of the Study:
- To identify reliable MRI-based predictors of PSM in patients undergoing robotic assisted radical prostatectomy (RPE).
- To analyze the utility of 3 Tesla multiparametric prostate MRI (mpMRI) in predicting PSM.
- To correlate specific MRI findings with the localization of PSM.
Main Methods:
- Retrospective analysis of 179 patients who underwent 3T mpMRI and RPE.
- Comparison of clinical and MRI parameters, including length of capsular tumor contact (LCC) and distance to membranous urethra (UD).
- Evaluation of MRI visibility of prostate cancer (PCA) at PSM sites.
Main Results:
- 27% of patients had PSM, predominantly at the capsule (apical/posterior) and apical urethra.
- Prostate cancer (PCA) was visible on mpMRI at PSM sites in 93% (capsule) and 80% (urethra).
- LCC (AUC 0.710), extraprostatic extension (EPE) (AUC 0.693), and UD (1-AUC 0.673) predicted overall PSM. UD ≤ 3.5 mm accurately predicted urethral PSM (95%), and LCC ≥ 22.5 mm predicted capsular PSM (77%).
Conclusions:
- PSM commonly occur at the capsule (apex/posterior) and apical urethra.
- LCC and UD are significant MRI predictors for PSM at specific locations.
- Pre-operative mpMRI parameters can help identify prostate cancer (PCA) localizations at risk for PSM.
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